Care Coordination Measure

DOI: 10.1177/1077558713508205
http://mcr.sagepub.com/content/early/2013/11/11/1077558713508205

Med Care Res Rev published online 13 November 2013             
Ron D. Hays, Steven Martino, Julie A. Brown, Mike Cui, Paul Cleary, Sarah Gaillot and
Marc Elliott

Evaluation of a Care Coordination Measure for the Consumer Assessment
of Healthcare Providers and Systems (CAHPS®) Medicare Survey

Abstract
There is widespread interest in assessing care coordination to improve overall care
quality. We evaluated a five-item measure of care coordination included in the 2012
Consumer Assessment of Healthcare Providers and Systems (CAHPS) Medicare survey
(n = 326,194 respondents, 46% response rate). This measure includes patient reports of
whether their personal doctor discusses their medicines, has medical records and other
relevant information, and is informed about care from specialists, and whether the patient
gets help in managing care and timely follow-up on test results. A one-factor categorical
confirmatory factor analytic model indicated that five items constituted a coherent scale.
Estimated health-plan-level reliability was 0.70 at about 102 responses per plan. The
composite had a strong unique association with the CAHPS global rating of health care,
controlling for the CAHPS core composite scores. This measure can be used to evaluate
relative plan performance and characteristics associated with better care coordination.

Prim Health Care. 2013 Apr 15;3. pii: 1000132.

Comparing Web-based with Mail Survey Administration of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinician and Group Survey.

Bergeson SC, Gray J, Ehrmantraut LA, Laibson T, Hays RD.

Source

Allina Health, Mail route 10307, Minneapolis, Minnesota, USA.

Abstract

CONTEXT:

The CAHPS^® survey instruments are widely used to assess patient experiences with care but there is limited information about web-based data collection with them.

OBJECTIVE:

To compare web-based data collection with standard mail survey mode of collection of CAHPS^® Clinician and Group survey data.

DESIGN SETTING AND PATIENTS:

We randomized mode of data collection (web versus mail) of the CAHPS^® Clinician and Group Survey to patients who had visited one of six clinics over a four-month period in Minnesota. A total of 410 patients responded to the web-based survey (14% response rate) and 982 patients responded to the mail survey (33% response rate).

MAIN OUTCOME MEASURES:

Responses to CAHPS^® survey dimensions and individual question responses, response rates, and participant characteristics.

RESULTS:

There were no significant differences in CAHPS^® survey composites and individual question responses by mode, except for those addressing access. Those responding via the web reported less positive experiences with access to an appointment for urgent care as soon as needed, getting an appointment for routine care as soon as needed, getting answers to medical questions as soon as needed, and follow-up on test results (t's=-3.64, -7.15, -2.58, -2.23; p's=0.0003, <0.0001, 0.01, 0.03, respectively). Web respondents had more positive experiences about office wait time for the most recent visit (t = 2.32, p=0.021). Those who participated in the study tended to be older than those that did not (ƛ²=247.51, df=8, p<0.0001 for mail; ƛ²= 4.56, df=8, p<0.0001 for the web). Females were significantly more likely than males to respond to the survey overall (24% vs. 18%, ƛ²=6.45, 1 df, p=0.011) and relatively more likely than males to respond to web (15% vs. 13%, ƛ²=1.32, 1 df, p=0.25) than mail (34% vs. 30%, ƛ²=5.42, 1 df, p=0.02). Mail respondents were more likely than web respondents to be male (28% versus 18%, ƛ²=16.27, 1 df, p<0.0001) and older (27% of the mail respondents and 19% of the web respondents were 65 or older, ƛ²=10.88, 1 df, p=0.001). Costs of web-based surveys were less than mailed surveys and were returned more quickly than mailed surveys. The correlations between reports and ratings of clinicians and clinics by mode were unreliable because of the relatively small number of web responses.

CONCLUSION:

Web-based surveys yielded comparable results to mail (except for questions addressing access) more quickly at lower costs. The low response rates in this study are a concern although this was not intended as a test of increasing response rates. Strategies to increase response rates will be a key element of web-based data collection. The differences in costs will be an incentive for organizations to continue to pursue web-based surveying. Further studies are needed to evaluate the generalizability of the results of this one.

Associations of cancer and other chronic medical conditons with SF-6D scores in Medicare beneficiaries

Hays, R.D., Reeve, B. B., Smith, A. W., & Clauser, S. B. (2013, epub).  Associations of cancer and other chronic medical conditions with SF-6D preference-based scores in Medicare beneficiaries.  Quality of Life Research.

Abstract

PURPOSE:

Documenting the impact of different types of cancer on daily functioning and well-being is important for understanding burden relative to other chronic medical conditions. This study examined the impact of 10 different cancers and 13 other chronic medical conditions on health-related quality of life.

METHODS:

Health-related quality of life data were gathered on the Medicare Health Outcomes Survey (MHOS) between 1998 and 2002. Cancer information was ascertained using the National Cancer Institute's surveillance, epidemiology, and end results program and linked to MHOS data.

RESULTS:

The average SF-6D score was 0.73 (SD = 0.14). Depressive symptoms had the largest unique association with the SF-6D, followed by arthritis of the hip, chronic obstructive pulmonary disease/asthma, stroke, and sciatica. In addition, the majority of cancer types were significantly associated with the SF-6D score, with significant negative weights ranging from -0.01 to -0.02 on the 0-1 health utility scale. Distant stage of cancer was associated with large decrements in the SF-6D ranging from -0.04 (prostate) to -0.08 (female breast).

CONCLUSION:

A large number of chronic conditions, including cancer, are associated uniquely with decrements in health utility. The cumulative effects of comorbid conditions have substantial impact on daily functioning and well-being of Medicare beneficiaries.

PMID: 23990395 [PubMed - as supplied by publisher]

Upper extremity and mobility subdomains from PROMIS physical functioning item bank

Hays, R. D., Spritzer, K. L., Amtmann, D., Lai, J-S., DeWitt, E. M., Rothrock, N., DeWalt, D. A., Riley, W. T., Fries, J. F., & Krishnan, E.  (2013, epub).  Upper extremity and mobility subdomains from the Patient-Reported Outcomes Measurement Information System (PROMIS®) adult physical functioning item bank. Archives of Physical Medicine and Rehabilitation. 

Arch Phys Med Rehabil. 2013 Jun 7. pii: S0003-9993(13)00424-3. doi: 10.1016/j.apmr.2013.05.014. [Epub ahead of print]

Upper Extremity and Mobility Subdomains from the Patient-Reported Outcomes Measurement Information System (PROMIS®) Adult Physical Functioning Item Bank.

Hays RD, Spritzer KL, Amtmann D, Lai JS, Dewitt EM, Rothrock N, Dewalt DA, Riley WT, Fries JF, Krishnan E.

Source

UCLA Division of General Internal Medicine & Health Services Research, Department of Medicine. 911 Broxton Avenue, Los Angeles, CA 90095-1736; RAND, 1776 Main Street, Santa Monica, CA 90407. Electronic address: drhays@ucla.edu.

Abstract

OBJECTIVE:

To create upper extremity and mobility subdomain scores from the Patient-Reported Outcomes Measurement Information System (PROMIS®) physical functioning adult item bank.

DESIGN:

Expert reviews were used to identify upper extremity and mobility items from the PROMIS item bank. Psychometric analyses were conducted to assess empirical support for scoring upper extremity and mobility subdomains.

SETTING:

Data were collected from the U.S. general population and multiple disease groups via self-administered surveys.

PARTICIPANTS:

The sample included 21,133 English-language adults who participated in the PROMIS wave 1 data collection and 640 Spanish-speaking Latino adults recruited separately.

INTERVENTIONS:

Not Applicable.

MAIN OUTCOME MEASURES:

We use English- and Spanish-language data and existing PROMIS item parameters for the physical functioning item bank to estimate upper extremity and mobility scores. In addition, we fit graded response models to calibrate the upper extremity items and mobility items separately, compare separate to combined calibrations, and produce subdomain scores.

RESULTS:

After eliminating items due to local dependency, 16 items remained to assess upper extremity and 17 items to assess mobility. The estimated correlation between upper extremity and mobility was 0.59 using existing PROMIS physical functioning item parameters (r = 0.60 using parameters calibrated separately for upper extremity and mobility items).

CONCLUSIONS:

Upper extremity and mobility subdomains shared about 35% of variance in common, and produced comparable scores whether calibrated separately or together. The identification of the subset of items tapping these two aspects of physical functioning and scored using the existing PROMIS parameters provides the option of scoring these subdomains in addition to the overall physical functioning score

 

 

Fayers and Hays (2013, May 31).

Fayers, P. M., & Hays, R. D.  (2013, May 31 published online first).  Don't middle your MIDs: Regression to the mean shrinks estimates of minimally important differences.  Quality of Life Research.

Abstract

Minimal important differences (MIDs) for patient-reported outcomes (PROs) are often estimated by selecting a clinical variable to serve as an anchor.  Then, differences in the clinical anchor regarded as clinically meaningful or important can be used to estimate the corresponding value of the PRO.  Although these MID values are sometimes estimated by regression techniques, we show this this is a biased procedure and should not be used; alternative methods are proposed.
http://link.springer.com/article/10.1007%2Fs11136-013-0443-4

Measuring acculturation in Asian Indian Survey Respondents

J Immigr Minor Health. 2013 May 7. [Epub ahead of print]

Validity of Temporal Measures as Proxies for Measuring Acculturation in Asian Indian Survey Respondents.

Bharmal N, Hays RD, McCarthy WJ.

Abstract

There are few validated acculturation measures for Asian Indians in the U.S. We used the 2004 California Asian Indian Tobacco Survey to examine the relationship between temporal measures and eleven self-reported measures of acculturation. These items were combined to form an acculturation scale. We performed psychometric analysis of scale properties. Greater duration of residence in the U.S., greater percentage of lifetime in the U.S., and younger age at immigration were associated with more acculturated responses to the items for Asian Indians. Item-scale correlations for the 11-item acculturation scale ranged from 0.28-0.55 and internal consistency reliability was 0.73. Some support was found for a two-factor solution; one factor corresponding to cultural activities (α = 0.70) and the other to social behaviors (α = 0.59). Temporal measures only partially capture the full dimensions of acculturation. Our scale captured several domains and possibly two dimensions of acculturation.

Quigley, D. D., Martino, S. C., Brown, J. A., & Hays, R.D.  (in press).  Confirmation and supplementation of CAHPS® Clinician and Group Survey communication items using feedback from high-performing physicians.  The Patient: Patient­Centered Outcomes
Research.

ABSTRACT

Background. A doctor’s ability to communicate effectively is key to establishing and maintaining positive doctor-patient relationships. The Consumer Assessment of Healthcare Providers and System (CAHPS®) Clinician and Group Survey is the standard for collecting and reporting information about patients’ experiences of care in the United States.

Objective. To evaluate how well CAHPS® Clinician and Group 2.0 core and supplemental survey items (CG-CAHPS) with a 12-month reference capture doctor-patient communication.

Data Sources/Study Setting. Eleven of the forty highest-rated physicians on the CG-CAHPS survey treating patients in a Midwest commercial health plan.

Study Design. Data were obtained via semi-structured interviews. Specific behaviors, practices and opinions about doctor communication were coded and compared to the CG-CAHPS items.

Principal Findings. CG-CAHPS fully captures six of the nine behaviors most commonly mentioned by high-performing physicians: employing office staff with good people skills; involving office staff in communication with patients; spending enough time with patients; listening carefully; providing clear, simple explanations; and devising an action plan with each patient. Three physician behaviors identified as key were not captured in CG-CAHPS items: use of non-verbal communication; greeting patients and introducing oneself; and tracking personal information about patients.

Conclusions. CG-CAHPS survey items capture many of the most commonly mentioned doctor-patient communication behaviors and practices identified by high-performing physicians. Non-verbal communication, greeting patients, and tracking personal information about patients were identified as key aspects of doctor-patient communication, but are not captured by the current CG-CAHPS. We recommend further research to assess patient’s perceptions of specific verbal and nonverbal behaviors (such as leaning forward in a chair, casually asking about other family members), followed by the development of new items (if needed) that aim to capture what these specific behaviors represent to patients (e.g., listens attentively, seems to care about me as a person, empathy). We also recommend including items about greeting and tracking personal information about patients in future CAHPS item sets addressing doctor-patient communication. Enriching the content of the CAHPS communication measure can help health care organizations improve doctor-patient communication and interactions.